Music Listening Among Postoperative Patients in the Intensive Care Unit: A Randomized Controlled Trial with Mixed-Methods Analysis

Nancy Ames, Rebecca Shuford, Li Yang, Brad Moriyama, Meredith Frey, Florencia Wilson, Thiruppavai Sundaramurthi, Danelle Gori, Andrew Mannes, Alexandra Ranucci, Deloris Koziol, Gwenyth R Wallen, Nancy Ames, Rebecca Shuford, Li Yang, Brad Moriyama, Meredith Frey, Florencia Wilson, Thiruppavai Sundaramurthi, Danelle Gori, Andrew Mannes, Alexandra Ranucci, Deloris Koziol, Gwenyth R Wallen

Abstract

Background: Music listening may reduce the physiological, emotional, and mental effects of distress and anxiety. It is unclear whether music listening may reduce the amount of opioids used for pain management in critical care, postoperative patients or whether music may improve patient experience in the intensive care unit (ICU).

Methods: A total of 41 surgical patients were randomized to either music listening or controlled non-music listening groups on ICU admission. Approximately 50-minute music listening interventions were offered 4 times per day (every 4-6 hours) during the 48 hours of patients' ICU stays. Pain, distress, and anxiety scores were measured immediately before and after music listening or controlled resting periods. Total opioid intake was recorded every 24 hours and during each intervention.

Results: There was no significant difference in pain, opioid intake, distress, or anxiety scores between the control and music listening groups during the first 4 time points of the study. However, a mixed modeling analysis examining the pre- and post-intervention scores at the first time point revealed a significant interaction in the Numeric Rating Scale (NRS) for pain between the music and the control groups (P = .037). The Numeric Rating Score decreased in the music group but remained stable in the control group. Following discharge from the ICU, the music group's interviews were analyzed for themes.

Conclusions: Despite the limited sample size, this study identified music listening as an appropriate intervention that improved patients' post-intervention experience, according to patients' self-report. Future mixed methods studies are needed to examine both qualitative patient perspectives and methodology to improve music listening in critical care units.

Keywords: ICU; Music; opioids; postoperative pain.

Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Study flow chart. Progression of study participants through consent and randomization.
Figure 2.
Figure 2.
Intravenous patient-controlled analgesia opioid use during intensive care unit (ICU) stay. Mean (arithmetic) doses of opioids taken during the stay in the ICU. Doses are reported as morphine. These doses include the continuous rate of the morphine as well as the patient-selected boluses. There was no significant difference between the music and control at any time point or for overall doses. If the opioid was delivered intravenously, then the opioid was converted to morphine. The conversion follows a standard equianalgesic table (see Supplementary Appendix B).
Figure 3.
Figure 3.
Epidural patient-controlled analgesia opioid intake during intensive care unit (ICU) stay. Mean (arithmetic) doses of fentanyl taken during the stay in the ICU. All doses were delivered using epidural catheters. These doses include the continuous rate of the morphine as well as the patient-selected boluses. There was no significant difference between the music and control at any time point or for overall doses. Sample size = 21.
Figure 4.
Figure 4.
Estimated marginal mean Numeric Rating Score before and after first intervention. Prescore (music = 20; control = 21); postscore (music = 17; control = 20). This figure displays the results of the mixed model for repeated measures for the Numeric Rating Scale (NRS) least square means for time point 1. There was a significant interaction effect between time point 1 pre/post NRS scores and the music group. Although the control group’s NRS scores remain relatively stable, the music group’s pain scores decreased. Although both NRS scores decreased, the music group’s decrease is more pronounced than the control.

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